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63 Cards in this Set

  • Front
  • Back
List effects of tumor on host. (7)
1. none
2. direct (mass) effect
3. local effects
4. Cancer cachexia
5. functional effects of tumors
6. paraneoplastic syndromes
7. death
What are 3 consequences of mass effects of tumors?
1. compression, destruction of adjacent structures
2. obliteration of bodycavity
3. obstrcution of hollow organ
List 4 types of local effects of tumors.
1. bleeding
2. infection
3. rupture
4 infarction
what is cancer cachexia?

What causes cachexia?
Wasting syndrome - Loss of body fat and lean body mass

Caused by incread metabolic rate --> catabolism
What are PIF and LMF? What produces PIF and LMF?

What are they associated with?
Both are produced by tumors.

PIF - proteolysis inducing factor; skeletal muscle breakdown

LMF - lipid-mobilizing factor; fatty acid oxidation and cytokine release (SIRS and skeletal muscle breakdown)

Associated with cancer cachexia
Name 3 non-paraneoplastic neoplasms that are associated with hormone secretion.

What are secreted by these tumors?
1. Parathyroid adenoma - secretes PTH

2. Pancreatic islet cell tumor - gastrin and insulin

3. Adrenal cortical neoplasm - cortisol and aldosterone
Secretion of hormones or hormone-like products by non-endocrine tumors is an example what syndrome?
paraneoplastic syndrome
What is paraneoplastic syndrome?
Symptom complexes in cancer-bearing patients that cannot readily be explained, either by the local or distant spread of the neoplasm, or by the elaboration of hormones indigenous to the tissue from which the tumor arose.
What syndrome most commonly associated with paraneoplastic endocrinopathy?
Cushing syndrome
Name 2 main cell types of lung carcinoma.
1. Small cell type

2. Squamous cell type
Small cell lung carcinoma is associated with secretion of what hormones? (2)
ACTH (Cushing Syndrome)

ADH (hyponatremia)
Squamous cell lung carcinoma is associated with secretion of what hormone?
PTHRP (PTH-related protein); hypercalcemia
What is the postulated etiology of neuromyopathic paraneoplastic syndromes?
Ectopic expression of neuronal antigens by tumor cells --> antibody production --> antibodies cross-react against antigens on neurons
Small cell lung carcinoma is associated what 2 neuromyopathic paraneoplastic syndromes?
Peripheral neuropathies

Myasthenic (Eaton-Lambert) syndrome
Breast carcinoma is associated what 2 neuromyopathic paraneoplastic syndromes?
Peripheral neuropathies

Cortical cerebellar degeneration
What is Acanthosis nigricans?

This is mainly associated with which cancer?
Velvety gray-black thickening of skin

GI adenocarcinoma
What 2 dematologic paraneoplastic disorders are associated with cancer?
Acanthosis nigricans

Dermatomyositis (heliotrope rash)
List 3 characteristics of hypertrophic pulmonary osteoarthropathy (HPO).

Which cancer is associated with HPO?
1. Periosteal new bone formation
2. arthritis of adjacent joints
3. clubbing of digits

Lung cancer in 1-10% of cases
Anemia is a paraneoplastic syndrome of which cancer?
Thymoma
Which cancer is associated polycythemia, paraneoplastically?
Renal cell carcinoma
What is Trousseau syndrome? This is associated which cancers (2)?
Troussaeu syndrome - migratory venous thrombosis

associated with visceral cancers, esp. pancreatic and lung cancers
What is NBTE?

NBTE is associted which cancer?
NBTE - nonbacterial thrombotic endocarditis; fibrinous vegetations on cardiac valves

Associated with mucin-secreting adenocarcinomas
What is the etiology behind paraneoplastic hypercoaguable states?
procoagulant effects of mucin and other tumor products
Define Grade and stage of neoplasm.
Grade - degree of differentiation of neoplastic cells

Stage - extent of spread of neoplasm within the patient.
What is the correlation b/t tumor grade and anaplasia?
lack of differentiation (anaplasia) = higher grade
What are the parameters of tumor grading?
all cancers: extent to which the neoplastic cells resemble or fail to resemble their normal counterparts

some cancers:
number of mitoses within the tumor
architectural features of the tumor
What are the parameters of measuring tumor staging?
1. size of primary lesion
2. extent of spread to regional lymph nodes
3. presence or absence of distant metastases (beyond regional lymph nodes)
1. What is a sentinel node?

2. How you ID the node?

3. Why do you want to ID the node?
1. the first node in a regional lymphatic basin that receive lymph flow from the primary tumor

2. Injection of colored dye or radiolabelled tracer at the leading edge and look for the node.

3. used to exclude regional lymph node metastases without complete dissection.
Describe the TNM tumor staging sysmtem.
T (primary tumor)
T0 = in-situ neoplasm
T1-T4 with increasing size of primary tumor

N (regional lymph nodes)
N0 = no lymph node involvement
N1-N3 with increasing number of involved lymph nodes

M (metastases)
M0 = no distant metastases
M1 = distant metastases present
What is the range of stages in the numerical system?

What stage is this tumor: T4N3M1?
I- IV (IV being the most advanced)

Stage IV
Which is more important: tumor stage or grade?

why?
Tumor stage b/c staging has proven to be of greater clinical value than grading in most cases.
What are minimum data required for pathologic diagnosis of tumor?
age of patient, site of lesion, relevant medical history
What reactive change may mimic cancer?
exuberant repair response (e.g. fracture, traumatic fat necrosis)

environmental exposures (radiation, drugs, toxins)
What type of specimens needs to be submitted to laboratory immediately?
fresh specimens with no preservative
What circumstances require immediate processing of the tissue biopsy?
Intraoperative diagnosis that will affect the course of surgical procedure.
when do you use frozen section diagnosis?

What is the disadvantage of using frozen sections?
for immediate viewing.

Inferior section quality
What are 2 ways of obtaining a biopsy for cytopathologic diagnosis?
1. exfoliative cytology

2. fine needle aspiration (FNA)
List 5 methods of diagnosing cancer that are not routinely used.
1. special stains
2. electron microscopy
3. immunohistochemistry (IHC0
4. flow cytometry
5. molecular diagnosis
What 4 antigens are used for categorizing undifferentiated malignant neoplasms in IHC?
1. Keratin for carcinoma (epithelial origin)
2. Vimetin for sarcoma (mesenchymal origin)
3. Leukocyte common antigen (LCA) for leukemia and lymphoma
4. S-100 protein for neural, melanocytic origin.
List 5 specifc antigens for differentiated neoplasms.
1. Desmin for muscle
2. Glial fibrillary acidic protein for glia
3. neurofilment for neurons
4. prostate-specific antigen (PSA)
5. Thyroglobulin for thyroid
What 2 things are identified by flow cytometry?
1. cell surface antigens
2. measurement of DNA content (e.g. aneuploidy)
What 2 types of profiling can be done using molecular evaluation of tumors?
Genomics

Proteomics
What is a tumor marker?

Can it be used for diagnosis? why or why not?
Tumor marker - biochemical or molecular indicator of the presence of a neoplasm

No, cannot be used due to low sensitivity and specificity
How are tumor markers used clinically?
to support the diagnosis of a particular type of cancer

Determining the response to therapy and in indicating recurrence.
What 2 genes are correlated with many, many different malignancies?
mutated p53 and mutated RAS
List 7 serum tumor markers we learned in this lecture.
1. Carcinoembryonic antigen (CEA)
2. alpha-fetoprotein (AFP)
3. Prostate- specific antigen (PSA)
4. Human Chorionic gonadotropin (HCG)
5. CA-125
6. Catecholamines
7. Calcitonin
CEA is a tumor marker for which malignancies (4)? Which one is most often observed
Carcinoembryonic antigen (CEA)

Colorectal - most often observed
Pancreatic
Gastric
Breast
AFP is a tumor marker for which malignancies (2)?
AFP - alpha-fetoprotein

Hepatocellular carcinoma
Germ cell tumors of testis
PSA is a tumor marker for which malignancy?
Prostate-specific antigen

Adenocarcinoma of the prostate
HCG is a tumor marker for which malignancies (2)?
Human chorionic Gonadotropin (HCG)

Trophoblastic neoplasms
Germ cell tumors of testis
CA-125 is a tumor marker for which malignancy?
ovarian carcinoma
Catecholamine is a tumor marker for which malignancies (2)?
Pheochromocytoma (mainly adults)

neuroblastoma (mainly children)
Calcitonin is a tumor marker for which malignancy?
medullary thyroid cancer
How are these tumors affecting the host?
Mass effects of tumor.

Left - obliteration of body cavity
Top right - compression, destruction of adjacent strctures
Bottom Right - obstruction of hollow organ
This is a picture of the lung.

What kind of cancer (be specific)?

What hormones are secreted by these cancer cells?
Small cell lung carcinoma

ACTH
ADH
This is a picture of the lung.

What type of cancer is this?

What is secreted? result of this secretion?
Squamous cell lung carcinoma

PTHRP (PTH related protein) --> hypercalcemia
What is the name of this disorder?

This is commonly associated with which cancer?
Acanthosis nigricans

GI Adenocarcinomas
What is this?

This is commonly associated with which 2 cancers?
Heliotrope rash (a type of dermatomyositis)

Lung and breast cancer
What is this?

This is commonly associated with which cancer?
Hypertrophic pulmonary osteoarthropathy (HPO)

Lung cancer
What is this?

What cancer is associated with this?
NBTE (nonbacterial thrombotic endocarditis)

mucin-secreting adenocarcinoma
Which picture has a higher tumor grade? why?
Right

More undifferentiated.
Which picture has a higher tumor grade? why?
Right

Less differentiation
This right slide is stained against cytokeratin.

What lab technique is utilized?
What type of general cancer are they looking for?
Immunohischemistry

carcinoma (cytokeratin is expressed on epithelial cells)